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SAN,,10A0UIN <br /> Environmellel Health Department <br /> —COUNTY— <br /> Greatness grows here, <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: CONSTRUCTION�� <br /> Facility Address: -�3) V <br /> Well Address: LD;P Total Depth: <br /> WP# '-Wl Well#: 11 , - Drilling Rig Type: <br /> Soil Boring#: N f C>c Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: V� �L„� <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: �y p..� s ��M�.��' Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: I Yes ❑No COMPLETIO ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes No casing <br /> If yes, location and distance: (( height <br /> 1' <br /> SAMPLING 9rT AWVE-GROUND <br /> Holding Temperature: COWLETION COMPLETION <br /> O <br /> Method: G=nd Sint" <br /> Screening Method: gro4A <br /> Verified Chain of Custody: ❑ Yes ❑No ft. <br /> ft. <br /> ft. <br /> SPOILS <br /> Contamination Noted: loin ❑ Yes ❑No n = <br /> If yes, spoils storage Location: slatted = . <br /> sac9on <br /> Covered: ELYes ❑No = „a <br /> Pack <br /> If yes, material: &N� . <br /> GROUTING or DESTRUCTION Total Depth: \\1,1IF <br /> _ <br /> Depth to Water: C_`h n' <br /> Grout Material: `IZZf <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENTN I� <br /> Casing Type: <br /> ❑Well Installation LAWell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> El Pressure GroutOver Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity [PTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas Rallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 <br /> 5 10 z 10 20 2 Bentonite per 94 Ib 2.82 <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 www.s'cehd.com <br />